天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (7): 824-828.doi: 10.11958/20160450

• 专题研究·胆道闭锁与肝移植 • 上一篇    下一篇

胆道闭锁儿童肝移植术后发生EB病毒感染的危险因素分析

王天成 ， 朱志军 ， 孙丽莹 ， 魏林 ， 曲伟 ， 曾志贵 ， 刘颖 ， 何恩辉 ， 张梁 ， 王永翠 ， 王玥   

  1. 1 天津医科大学研究生院（邮编 300070）； 2首都医科大学附属北京友谊医院普外科， 国家消化系统疾病临床医学研究中心， 移植耐受与器官保护北京市重点实验室；3 首都医科大学附属北京友谊医院超声科， 4麻醉科
  • 收稿日期:2016-05-23 修回日期:2016-06-15 出版日期:2016-07-15 发布日期:2016-07-15
  • 通讯作者: 王天成 E-mail:wtiancheng125@sina.com
  • 作者简介:王天成（1988）， 男， 硕士研究生在读， 主要从事肝移植及肝胆外科研究
  • 基金资助:
    北京市卫生系统高层次卫生技术人才培养计划项目（2014-2-002）

Risk factor analysis of EB virus infection after liver transplantation in children with biliary atresia

WANG Tiancheng1， ZHU Zhijun2△， SUN Liying2， WEI Lin2， QU Wei2， ZENG Zhigui2， LIU Ying2， HE Enhui3，ZHANG Liang4， WANG Yongcui1， WANG Yue1   

  1. 1 Graduate School of Tianjin Medical University， Tianjin 300070， China; 2 Department of General Surgery， Beijing Friendship Hospital Affiliated to Capital Medical University， National Clinical Research Center for Digestive Diseases， Beijing Key Laboratory of Tolerance and Organ Protection in Transplantation; 3 Department of Ultrasound,4 Department of Anesthesia， Beijing Friendship Hospital Affiliated to Capital Medical University
  • Received:2016-05-23 Revised:2016-06-15 Published:2016-07-15 Online:2016-07-15
  • Contact: Tian-Cheng WANG E-mail:wtiancheng125@sina.com

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摘要： 目的 探讨胆道闭锁患儿肝移植术后 EB 病毒（EBV）感染的发生情况及危险因素。 方法 回顾性分析因胆道闭锁致肝硬化接受肝脏移植的 65 例患儿的临床资料， 据 EBV 感染情况分成感染组 30 例与非感染组 35 例， 对所有患儿的肝移植术前、术中及术后等资料进行单因素分析， 并将组间比较 P＜ 0.1 的变量纳入多因素 Logistic 回归分析中， 筛选胆道闭锁患儿肝移植术后 EBV 感染的危险因素。 结果 在 65 例肝移植受者中， 共有 30 例（46.15%）出现 EBV 感染， 其中 23 例（76.67%）发生于术后 3 个月内。 单因素分析显示， 2 组间手术时年龄＜ 1 岁、供者 EBV 血清学阳性而受者 EBV 血清学阴性、术后发生排斥反应、术后联合应用骁悉抗排异的比例以及术后他克莫司药物谷值浓度超过目标浓度的次数差异有统计学意义（P＜ 0.05）； 将上述变量及采用亲体供肝（P=0.060）、术中红细胞输入量 （P=0.063）同时纳入多因素 Logistic 回归分析， 结果显示， 供者 EBV 血清学阳性而受者 EBV 血清学阴性、术后发生急性排斥反应、术后他克莫司药物浓度超过目标浓度次数多是胆道闭锁患儿肝移植术后发生 EBV 感染的危险因素。结论 供者 EBV 血清学阳性而受者 EBV 血清学阴性、术后发生急性排斥反应及术后他克莫司药物谷值浓度多次超过目标浓度与胆道闭锁患儿肝移植术后发生 EBV 感染密切相关， 对此类患儿应给予适当的抗病毒药物预防 EBV感染。

关键词: 胆道闭锁, 肝移植, 疱疹病毒 4 型, 人, 危险因素, 儿童

Abstract: To determine the prevalence and risk factors of Epstein- Barr virus (EBV) infection after pediatric liver transplantation for patients with biliary atresia. Methods Clinical data of 65 pediatric patients with biliary atresia, who underwent liver transplantation, were retrospectively analyzed. Patients were divided into EBV infection group(n=30) and non-EBV infection group (n=35). The univariate analysis was used to analyse the preoperative, intraoperative and postoperative data of patients included. The variables with a P ＜ 0.1 were included in the multivariate Logistic regression analysis of EBV infections after pediatric liver transplantation for patients with biliary atresia. Results A total of 30 cases (46.15%) of pediatric recipients showed EBV infection in 65 cases, of which 23 cases (76.67%) occurred within 3 months after operation. The univariate analysis showed that there were significant differences in the ratio of patients younger than 1 year preoperation, EBV serology D+/R-, acute rejection, the usage of mycophenolate mofetil and supratheraputic tacrolimus level between two groups (P＜ 0.05) . The type of graft (P=0.060), input quantity of red blood cell intraoperation (P=0.063) and factors mentioned above were included in the multivariate Logistic regression analysis. It revealed that donor EBV serology positive but recipient negative, acute rejection and supratheraputic tacrolimus level were risk factors of EBV infection for pediatric liver transplantation recipients with biliary atresia. Conclusion Donor EBV serology positive but recipient negative, acute rejection, supratheraputic tacrolimus level are closely related to EBV infection in pediatric recipients with biliary atresia after liver transplantation. Appropriate antiviral drugs should be adopted to prevent EBV infection in high risk patients.

Key words: biliary atresia, liver transplantation, herpesvirus 4, human, risk factors, child